Rotator cuff tears associated with glenohumeral instability

Study finds that patient age and number of previous dislocations are not related to Bankart and capsular lesions.

Patients who have rotator cuff and capsular lesions, as well as a recent shoulder dislocation, consistently also have glenoid labrum or glenohumeral ligament lesions, Italian researchers found.

However, that number of previous dislocations does influence posterosuperior cuff tears, the authors noted.

Giuseppe Porcellini, MD, an orthopedic surgeon in Cattolica, Italy, and colleagues conducted the study, which reviewed their experience arthroscopically treating all patients aged 40 to 60 years at their center for rotator cuff lesions, shoulder instability or both from January 2000. They noted that it is not possible to determine whether a lesion of the capsular-labral complex or the rotator cuff actually causes or follows a dislocation.

“Although data do not permit us to conclude [neither] whether repair of the sole cuff tear can achieve shoulder stability nor whether shoulder stabilization alone can resolve the instability, treatment of both lesions should be performed arthroscopically,” the authors said in the study, published in the journal Arthroscopy.

Three study groups

For the study, Porcellini and colleagues separated patients into three study groups: shoulder instability (Group I), complete rotator cuff tear (Group C) and instability plus complete rotator cuff tear (Group IC). They only included patients aged 40 to 60 years, which was “dictated by the prevalence of pure instability among younger patients and of pure cuff lesions among older patients,” the authors said in the study.

By May 2002, 50 patients remained in each group. For all patients in Groups I and IC, the most recent dislocations occurred during the previous three months. For all groups, preoperative clinical examinations showed a slight range of motion (ROM) decrease in external rotation compared to the contralateral shoulder.

All patients in Group I had capsular and labral lesions, which were isolated in 41 cases and associated in nine, the authors said. The researchers also found 18 cases (36%) of isolated Bankart lesions, and 23 cases (46%) of either isolated or longitudinal capsular lesions and either ligament detachment from the glenoid labrum or from the humeral side. For patients in Group C, surgeons intraoperatively identified isolated tears in 29 cases and associated tears in 21, according to the study.

Patients in Group IC suffered from recurrent anterior shoulder dislocation associated with a cuff tear. Intraoperatively, surgeons found 25 cases of isolated tears and 25 cases of associated tears. Lesions related to instability included 12 (24%) isolated Bankart lesions, 18 (36%) isolated capsular lesions and 20 (40%) associated lesions of the labrum and capsule, according to the study.

Correlation among lesions

The researchers used the Pearson correlation coefficient and the X² test to determine any correlations among lesions. For patients in Group I and Group IC, they found no relationship between the amount of dislocation and patient age (P>.1) to either the Bankart or capsular articular lesions noted intraoperatively.

Although not significant, they also found slightly more capsular lesions related to instability independently of age, cuff lesions and number of dislocations (P>.1). Additionally, they found no correlation between either capsular or Bankart lesions and the presence of rotator cuff tears (P>.5), according to the study.

However, “the rising number of dislocations correlated strongly (P<.001) with a greater number of posterosuperior lesions of the rotator cuff, supraspinatus and infraspinatus — a correlation that was even stronger in patients who had experienced seven or more dislocations,” the authors said.

The researchers obtained postoperative scores at least two years postop. In all patients, Constant and Rowe scores rose significantly and consistently from preop. The Rowe score increased from 48.93 to 77.6 in Group I (P<.001), from 39.47 to 78.9 in Group IC (P<.001), and from 76.63 to 85.4 in Group C (P<.01), according to the study.

For more information:
Porcellini G, Paladini P, Campi F, Paganelli. Shoulder instability and related rotator cuff tears: Arthroscopic findings and treatment in patients aged 40 to 60 years. Arthroscopy. 2006;22:270-276.